International experience in organizing emergency medical care for the population in emergency situations. OBZhD

BASICS OF SAFE LIFE
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International experience in organizing emergency medical care for the population in emergency situations

Fundamentals of Safe Life Activities (OBZhD)

In recent decades, the scientific and practical direction has been intensively developing all over the world. "Emergency Medicine"associated with the provision of emergency medical care (EMA) simultaneously to a large number of affected. Disaster medicine is an integral part of the emergency response system in extreme situations.

The experience of the world community in the management of emergency medical forces in emergencies, the organization of the federal and regional levels of government and their interaction is of considerable interest.

Emergency response systems began to be created in various countries after a series of major chemical accidents (Bhopal, India - 1984; Seveso, Italy - 1975; Abbisted, UK - 1984, etc.) . In the USA since the second half of the 80s. The Environment Agency is working intensively to establish a rapid response system for chemical accidents. In Europe, in 1987, the United Nations Environment Program (UNEP) launched the APELL (Awareness and Preparedness for Emergencies at the Local Level) project. APELL contains recommendations for raising local community awareness of potentially hazardous businesses and is designed to prepare coordinated emergency response plans. This is a system of actions in case of industrial accidents.

В USA at the state level, several departments are responsible for the development of measures and the definition of a general policy for the prevention and elimination of the consequences of catastrophes and natural disasters, reporting directly to the president of the country. The main agency that plays a major role in disasters is FEMA (Federal Emergency Management Agency). It coordinates the activities of state civil defense agencies, federal ministries and departments (Ministry of Energy, Ministry of Transportation, etc.) and private sector enterprises.

FEMA, in addition, provides training, public education and dissemination of information on civil defense issues, research and development, solving problems in the fight against terrorism, control over the use of electronic media during a state of emergency, and interaction with the Armed Forces. FEMA is directly connected to regional and state emergency response centers. The City Center is interconnected with the following agencies and organizations: public utilities, schools, military units, hospitals and other medical institutions, including the military, the American Red Cross, the Salvation Army, insurance agencies, fire agencies, county investigation department, local amateur radio societies, transport agencies. Emergency medical care in the United States is provided through the National Disaster Medical System (NDMS).

Responsible for NDMS are the Department of Health and Welfare and the Department of Defense. Financial support is provided by FEMA and the Veterans Committee. NDMS is engaged in the planning of organizational, evacuation, sanitary and hygienic and medical measures, the organization of detachments of specialized medical care and the distribution of the injured to hospitals in the event of a disaster. In accordance with the directive of the President, the Ministry of Health and Social Welfare, responsible for the medical support of the civilian population in the event of an emergency, manages the medical service of the Civil Defense.

In France a decentralized form of coordination of rescue operations has been adopted. Each department and large locality has a special system of forces and means to eliminate the consequences of natural disasters or accidents that lead to the appearance of a large number of victims.

The signal about the catastrophe is first sent to the police, and then transmitted to the Central Council for the Organization and Assistance of the Prefectural Services. In 1956, the emergency medical service Service Aide Medicale d' Urgence - SAMU was created. General practitioners, surgeons, anesthesiologists, resuscitators and paramedical personnel are on duty around the clock at each of the 97 points. In addition, SAMU is staffed by specialists who are constantly working in other institutions (medical, police, fire, transport, etc.) and who have undergone special training in a 400-hour program.

An important role in the system of providing emergency assistance to people affected by emergencies is played by the formation of voluntary rescuers (secourism) - very popular in France at the present time. There is another term - sauver, which means - a rescuer. Very often, these two concepts appear simultaneously. The French Associations of Volunteer Rescuers have shown their effectiveness in practice, especially when these voluntary units have been provided with the necessary equipment.

The mass movement to provide first aid, as they believe in France, must develop. Great attention is paid to the creation of rescue teams, the state, the authorities of departments and cities provide assistance and support.

According to France, the purpose of first aid is to take all necessary emergency measures in case of a threat to the vital functions of the body. A certified lifeguard must be able to bring a person out of a critical condition. Well-trained rescuers are easily included in rescue activities in case of major disasters.

In specialized ambulance teams, certified rescuers take on the functions of leaders of such teams, and the medical personnel in them perform only their immediate duties.

В Germany the emergency ambulance system includes elements of disaster medicine in the United States and France.

In the event of a disaster, all federal and municipal services, fire departments, as well as auxiliary services and charitable unions are involved in assisting with the police. For example, in Bavaria there are about 7800 voluntary fire brigades, numbering approximately 348 thousand firefighters, 6 professional and about 400 factory and production fire brigades. Their competence includes not only fire protection, but also the provision of technical assistance in case of disasters and other emergencies. Among the voluntary support services, the most

a large organization is the Bavarian Red Cross, which has the aid train "Bavaria" as a federal reserve for regional large-scale cases. The train provides assistance to approximately 4000 people through the medical and maintenance services. In addition, it has 19 fully equipped infectious diseases hospitals.

В Sweden the emergency medical service for disasters, similar to the French one, is run by the fire department of the Ministry of the Interior of the country.

In 1975, the Swedish Association for Emergency Medicine was formed with the aim of improving disaster management skills. With the help of the Association, an intensive course is being held for the ambulance service and rescuers. The purpose of the training is to develop skills to help victims of fires and explosions, structural failures, landslides, floods and storms, traffic accidents, radioactive contamination of the area, oil spills and hazardous chemicals.

In 1986, the National Directorate of Rescue Services was established, which manages the emergency work of rescuers of 284 local governments in emergency situations. It is responsible for the organization and training of municipal and communal rescue services, provides reference and advisory assistance during their work in extreme situations, provides the population with all the necessary information, etc. In emergency situations, medical institutions in Sweden become subordinate to the civil defense command of the appropriate level and are ready to accept up to 200 thousand affected (total population - 8 million people). In addition, 92 fixed hospitals, 90 temporary hospitals and 76 separate health posts can be deployed. For this purpose, appropriate stocks of medicines, medical equipment and other material resources have been created in state, municipal and communal warehouses.

В UK The Ministry of Internal Affairs is the central body coordinating the activities of the emergency service in the country.

In the government, in addition to the Ministry of Internal Affairs, the lead ministry, which is in charge of the area or object in the disaster zone, participates in coordinating the preparation and conduct of emergency rescue operations. Along with the Ministry of the Interior, it informs the government, parliament and the population about the incident and the progress of the liquidation of its consequences. In case of major disasters, after an assessment by the lead ministry of the scale and nature of the emergency situation, the Cabinet of Ministers develops the necessary decisions to intensify rescue operations and provide assistance to local authorities, relevant services and the population.

В Belgium the emergency response system includes 5 crisis centers staffed by professional specialists. They are led by the Ministry of Internal Affairs of the country. The centers are equipped with the necessary technical means for localizing accidents and saving people.

The management of forces and means of potentially dangerous facilities, as well as crisis centers, is carried out in a single information support system. The training of emergency rescue units and specialists of enterprises in Belgium is organized on the basis of a special center equipped with the necessary equipment and staffed by qualified teachers. It has a training ground, training places have been created for practicing practical actions in an emergency.

In Belgium, a serious legislative framework has been created in the field of emergency prevention and protection of the population. Only in this country has a law passed on the taxation of industrial firms operating high-risk facilities. The insurance system also differs from the Russian one, being an effective economic lever that increases the interest of company managers in ensuring the safety of their facilities.

В Holland The national plan provides for the use of 20 hospitals in the event of an emergency, each of which has an emergency medical team consisting of a surgeon, an anesthesiologist and two nurses. If necessary, these teams are sent to the crash site and provide assistance to 200 injured per hour.

The system of joint rapid reaction forces of European countries is made up of mobile medical teams and detachments organized on the basis of multidisciplinary hospitals. Their activities begin with preliminary medical reconnaissance carried out in the disaster area, which allows assessing the situation: determining the approximate number of victims, the nature and severity of injuries, the need for specific specialists, medical equipment, medicines, dressings and other material and technical means.

The study of foreign experience shows that each country has its own characteristics in the creation of systems for the protection and rescue of the population in emergencies. And although most authors note that the best results can be achieved with centralized leadership, the experience of France suggests otherwise.

Taking into account the accumulated experience in eliminating the medical consequences of accidents and disasters, specialists put forward the professional training of personnel, the early implementation of measures to ensure the material and technical base, communication and interaction of various emergency services, as well as international cooperation.

Authors: Aizman R.I., Krivoshchekov S.G.

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